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Cited by 408Diabetes Treatment and ManagementDiabetes Management and ResearchPharmaceutical Practices and Patient Outcomes

Potential overtreatment of diabetes mellitus in older adults with tight glycemic control

Open access
Lipska, Kasia J., Ross, Joseph S., Miao, Yinghui, Shah, Nilay D., Lee, Sei J., Steinman, Michael A.·2015·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2014.7345PMC PMC4426991
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Abstract

IMPORTANCE: In older adults with multiple serious comorbidities and functional limitations, the harms of intensive glycemic control likely exceed the benefits. OBJECTIVES: To examine glycemic control levels among older adults with diabetes mellitus by health status and to estimate the prevalence of potential overtreatment of diabetes. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of the data on 1288 older adults (≥65 years) with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2010 who had a hemoglobin A1c (HbA1c) measurement. All analyses incorporated complex survey design to produce nationally representative estimates. EXPOSURES: Health status categories: very complex/poor, based on difficulty with 2 or more activities of daily living or dialysis dependence; complex/intermediate, based on difficulty with 2 or more instrumental activities of daily living or presence of 3 or more chronic conditions; and relatively healthy if none of these were present. MAIN OUTCOMES AND MEASURES: Tight glycemic control (HbA1c level, <7%) and use of diabetes medications likely to result in hypoglycemia (insulin or sulfonylureas). RESULTS: Of 1288 older adults with diabetes, 50.7% (95% CI, 46.6%-54.8%), representing 3.1 million (95% CI, 2.7-3.5), were relatively healthy, 28.1% (95% CI, 24.8%-31.5%), representing 1.7 million (95% CI, 1.4-2.0), had complex/intermediate health, and 21.2% (95% CI, 18.3%-24.4%), representing 1.3 million (95% CI, 1.1-1.5), had very complex/poor health. Overall, 61.5% (95% CI, 57.5%-65.3%), representing 3.8 million (95% CI, 3.4-4.2), had an HbA1c level of less than 7%; this proportion did not differ across health status categories (62.8% [95% CI, 56.9%-68.3%]) were relatively healthy, 63.0% (95% CI, 57.0%-68.6%) had complex/intermediate health, and 56.4% (95% CI, 49.7%-62.9%) had very complex/poor health (P = .26). Of the older adults with an HbA1c level of less than 7%, 54.9% (95% CI, 50.4%-59.3%) were treated with either insulin or sulfonylureas; this proportion was similar across health status categories (50.8% [95% CI, 45.1%-56.5%] were relatively healthy, 58.7% [95% CI, 49.4%-67.5%] had complex/intermediate health, and 60.0% [95% CI, 51.4%-68.1%] had very complex/poor health; P = .14). During the 10 study years, there were no significant changes in the proportion of older adults with an HbA1c level of less than 7% (P = .34), the proportion with an HbA1c level of less than 7% who had complex/intermediate or very complex/poor health (P = .27), or the proportion with an HbA1c level of less than 7% who were treated with insulin or sulfonylureas despite having complex/intermediate or very complex/poor health (P = .65). CONCLUSIONS AND RELEVANCE: Although the harms of intensive treatment likely exceed the benefits for older patients with complex/intermediate or very complex/poor health status, most of these adults reached tight glycemic targets between 2001 and 2010. Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia. Our findings suggest that a substantial proportion of older adults with diabetes were potentially overtreated.

AI snapshot

Written from the paper’s full text.

TL;DR

In a nationally representative NHANES sample of older US adults with diabetes from 2001–2010, most had tight glycemic control (HbA1c <7%), including many with complex/intermediate or very complex/poor health. Many of these adults were treated with insulin or sulfonylureas, suggesting substantial potential overtreatment.

Key findings

  • Among 1288 older adults with diabetes, 61.5% (95% CI, 57.5%–65.3%), representing 3.8 million US adults, had HbA1c <7%; this proportion did not differ significantly by health status: 62.8% relatively healthy, 63.0% complex/intermediate, and 56.4% very complex/poor (P = .26).
  • Of those with HbA1c <7%, 54.9% (95% CI, 50.4%–59.3%) were treated with insulin or sulfonylureas; treatment was similar across health status categories: 50.8% relatively healthy, 58.7% complex/intermediate, and 60.0% very complex/poor (P = .14).
  • Among adults with complex/intermediate or very complex/poor health, approximately 60% (or 1.0 million) with HbA1c <7% were treated with insulin or sulfonylureas.
  • Over the 10 study years, there were no significant trends in the proportion with HbA1c <7% (P = .34), the proportion with HbA1c <7% who had complex/intermediate or very complex/poor health (P = .27), or treatment with insulin/sulfonylureas among those with complex/intermediate or very complex/poor health (P = .65).

Methods

  • Cross-sectional analysis of NHANES data from 2001–2010, including 1288 adults aged ≥65 years with self-reported diabetes and an HbA1c measurement; analyses incorporated complex survey design to produce nationally representative estimates.
  • Health status was classified using the ADA/AGS framework: very complex/poor health if dialysis-dependent or ≥2 ADL impairments; complex/intermediate health if ≥3 chronic conditions or ≥2 IADL impairments; relatively healthy if neither.
  • Outcomes were tight glycemic control (HbA1c <7%; also examined <6.5%) and use of diabetes medications likely to cause hypoglycemia (insulin or sulfonylureas); weighted proportions and logistic regression were used to assess trends.

Limitations

  • The paper states that combining NHANES cycles may have underpowered detection of subtle trends; medication use relied on prescriptions brought to examination, with some combination therapies not subcategorized; health status used limited ADL/IADL questions and did not account for dementia or cognitive impairment, possibly overestimating relatively healthy adults and underestimating overtreatment; NHANES excludes institutionalized adults; direct harm such as hypoglycemia could not be determined; HbA1c is a poor predictor of self-reported serious hypoglycemia; and a possible shift in HbA1c distribution toward higher values may underestimate overtreatment.
  • Evident from the text: the cross-sectional design cannot establish causality between treatment and outcomes, and the study lacked data on active cancer, clinical depression, falls, and other ADL/IADL impairments used in the ADA/AGS framework.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamainternmed.2014.7345

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    A total of 41.9% of older adults had an HbA1c level of less than 6.5%.

    “A total of 41.9% (95% CI, 37.9%–46.1%) of older adults had an HbA1c level of less than 6.5%”
    Quote in the paperSubstantial claim
  • Findingown data

    43.9% of relatively healthy older adults with HbA1c <6.5% were treated with insulin or sulfonylureas.

    “Similarly, large proportions of participants with HbA1c levels of less than 6.5% were treated with insulin or sulfonylureas across health status categories (43.9% [95% CI, 36.8%–51.3%] of relatively healthy, 52.3% [95% CI, 40.4%–64.0%] with complex/intermediate health, and 56.3% [95% CI, 44.1%–67.8%] with very complex/poor health).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among older adults with diabetes, 32.2% had an HbA1c level of 7% to 8.9%.

    “32.2% (95% CI, 28.7%–35.9%) had an HbA1c level of 7% to 8.9%”
    Quote in the paperSubstantial claim
  • Findingown data

    Most older adults with complex/intermediate or very complex/poor health who reached tight glycemic targets were treated with insulin or sulfonylureas.

    “Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia.”
    • Also stated in: § Discussion · plain
      “Moreover, approximately 60% (or 1.0 million) of adults with complex or very complex medical problems were treated with insulin or sulfonylureas to achieve tight glycemic targets, which may lead to severe hypoglycemia.”
    Quote in the paperSubstantial claim
  • Findingown data

    28.1% had complex/intermediate health.

    “28.1% (95% CI, 24.8%–31.5%), representing 1.7 million (95% CI, 1.4–2.0), had complex/intermediate health”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 14

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    21.2% had very complex/poor health.

    “21.2% (95% CI, 18.3%–24.4%), representing 1.3 million (95% CI, 1.1–1.5), had very complex/poor health.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Current recommendations for diabetes management endorse higher glycemic targets for older patients with multiple comorbidities, functional impairments, established diabetic complications, or limited life expectancy.

    “Current recommendations for diabetes management,2,11,12 including The 2012 ADA and American Geriatrics Society (AGS) consensus statement,13 endorse higher glycemic targets for older patients with multiple comorbidities, functional impairments, established diabetic complications, or limited life expectancy.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [2] American Diabetes Association Standards of medical care in diabetes: 2014 Diabetes Care 2014 37 suppl 1 S14 S80 24357209

      Not checked in the free run.

    • cites [11] Management of Diabetes Mellitus Update Working Group VA/DoD clinical practice guideline: management of diabetes mellitus (2010). Version 4.0 Washington, DC Veterans Health Administration and Department of Defense 2010 http://www.healthquality.va.gov/guidelines/CD/diabetes/DM2010_SUM-v4.pdf Accessed November 26, 2014

      Not checked in the free run.

    • cites [12] Brown AF Mangione CM Saliba D Sarkisian CA California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes Guidelines for improving the care of the older person with diabetes mellitus J Am Geriatr Soc 2003 51 5 suppl guidelines S265 S280 12694461

      Not checked in the free run.

    • cites [13] Kirkman MS Briscoe VJ Clark N Diabetes in older adults Diabetes Care 2012 35 12 2650 2664 23100048 PMC3507610

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Glucose-lowering agents have been implicated in one-fourth of emergency hospitalizations for adverse drug events in older US adults, nearly all of them for hypoglycemia.

    “Glucose-lowering agents have been implicated in one-fourth of emergency hospitalizations for adverse drug events in older US adults, nearly all of them for hypoglycemia.9”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Budnitz DS Lovegrove MC Shehab N Richards CL Emergency hospitalizations for adverse drug events in older Americans N Engl J Med 2011 365 21 2002 2012 22111719

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    We could not determine the presence of other indicators of very complex/poor health status per the ADA/AGS framework, including end-stage congestive heart failure, oxygen-dependent lung disease, uncontrolled metastatic cancer, or severe cognitive impairment.

    “We could not determine the presence of other indicators of very complex/poor health status per the ADA/AGS framework, including end-stage (stage III–IV) congestive heart failure, oxygen-dependent lung disease, uncontrolled metastatic cancer, or severe cognitive impairment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All analyses incorporated complex survey design to produce nationally representative estimates.

    “All analyses incorporated complex survey design to produce nationally representative estimates.”
    • Also stated in: § Statistical Analysis · plain
      “All analyses incorporated a complex survey design using NHANES-recommended methods to produce nationally representative estimates.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    We did not include hypertension because it is highly prevalent and usually not considered a serious chronic illness.

    “We also did not include hypertension because it is highly prevalent and usually not considered a serious chronic illness.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    We classified older adults with diabetes into 3 health status categories endorsed by the ADA/AGS framework for considering treatment goals for glycemia.

    “We classified older adults with diabetes into 3 health status categories endorsed by the ADA/AGS framework for considering treatment goals for glycemia.13”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Kirkman MS Briscoe VJ Clark N Diabetes in older adults Diabetes Care 2012 35 12 2650 2664 23100048 PMC3507610

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Receipt and type of oral glucose-lowering treatment was based on review of medications brought in to the examination; insulin use was based on review of medications brought in or self-reported use of insulin.

    “Receipt and type of oral glucose-lowering treatment was based on review of medications brought in to the examination; insulin use was based on review of medications brought in or self-reported use of insulin, because participants may not always bring vials or pens to the examination.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To preserve statistical power in trend analyses, we combined participants with complex/intermediate and very complex/poor health status into 1 category.

    “To preserve statistical power in these trend analyses, we combined participants with complex/intermediate and very complex/poor health status into 1 category.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    We did not have information on active cancer, clinical diagnosis of depression, or falls.

    “we did not have information on active cancer, clinical diagnosis of depression, or falls.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The NHANES uses stratified, multistage, probability-cluster techniques to ensure that sample populations are representative of the nation's noninstitutionalized civilians.

    “The NHANES uses stratified, multistage, probability-cluster techniques to ensure that sample populations are representative of the nation’s noninstitutionalized civilians.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Laboratory method crossover studies were conducted at the time of each of the laboratory instrument changes.

    “Laboratory method crossover studies were conducted at the time of each of the laboratory instrument changes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Intensive glycemic control is unlikely to result in a benefit for older patients with multiple comorbidities, functional impairments, established diabetic complications, or limited life expectancy, but it is associated with a risk for harm.

    “The reasons for higher glycemic targets in these persons are 2-fold: intensive glycemic control is unlikely to result in a benefit, but it is associated with a risk for harm.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Other ADLs and instrumental ADLs were not assessed in the NHANES.

    “Other ADLs and instrumental ADLs were not assessed in the NHANES.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The study was deemed exempt from further review by the University of California, San Francisco, Institutional Review Board because it used only deidentified secondary data.

    “This study was deemed exempt from further review by the University of California, San Francisco, Institutional Review Board because it used only deidentified secondary data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Both laboratories that analyzed NHANES HbA1c data from 2001-2010 were standardized by participating in the National Glycohemoglobin Standardization Program, and no adjustment across years for the HbA1c assay has been recommended.

    “Both laboratories that analyzed NHANES HbA1c data from 2001–2010 were standardized by participating in the National Glycohemoglobin Standardization Program, and no adjustment across years for the HbA1c assay has been recommended.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Some combinations of comorbid conditions used to categorize health status may have stronger associations with hypoglycemia and life expectancy than others; however, to the extent possible, we have followed the ADA/AGS framework, which does not distinguish between these combinations.

    “Some combinations of comorbid conditions used to categorize health status may have stronger associations with hypoglycemia and life expectancy than others; however, to the extent possible, we have followed the ADA/AGS framework,13 which does not distinguish between these combinations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Kirkman MS Briscoe VJ Clark N Diabetes in older adults Diabetes Care 2012 35 12 2650 2664 23100048 PMC3507610

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    We incorporated functional impairments, which are an important risk factor for adverse outcomes in diabetes treatment but are not captured in administrative records such as those used in the study by Tseng et al.

    “In addition, we incorporated functional impairments, which are an important risk factor for adverse outcomes in diabetes treatment but are not captured in administrative records such as those used in the study by Tseng et al.19”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Tseng CL Soroka O Maney M Aron DC Pogach LM Assessing potential glycemic overtreatment in persons at hypoglycemic risk JAMA Intern Med 2014 174 2 259 268 24322626

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The ADA has only recently endorsed individualized glycemic targets, and it is possible that potential overtreatment may have declined since 2010; however, the Veteran Affairs and AGS guidelines have endorsed this approach for nearly a decade and we detected no signal to suggest a change.

    “The ADA has only recently endorsed individualized glycemic targets, and it is possible that potential overtreatment may have declined since 2010; however, the Veteran Affairs and AGS guidelines have endorsed this approach for nearly a decade and we detected no signal to suggest a change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We were not able to determine whether potential overtreatment directly resulted in harm, such as hypoglycemia.

    “We were not able to determine whether potential overtreatment directly resulted in harm, such as hypoglycemia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Our study may have been underpowered to detect more subtle changes in treatment patterns over time.

    “We combined NHANES data from 2001 through 2010 to increase our sample size, but our study may have been underpowered to detect more subtle changes in treatment patterns over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    These vulnerable adults are unlikely to experience the benefits of intensive glycemic control and instead are likely to experience harms from treatment, such as hypoglycemia and other adverse effects.

    “These vulnerable adults are unlikely to experience the benefits of intensive glycemic control and instead are likely to experience harms from treatment, such as hypoglycemia and other adverse effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    We used nationally representative samples (with equal numbers of men and women) served by different health systems that are more generalizable to the US population at large.

    “We used nationally representative samples (with equal numbers of men and women) served by different health systems that are more generalizable to the US population at large.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Given incomplete information on all comorbidities in our study, it is likely that we underestimated the complexity of health status, and thus, true estimates of adults who are potentially overtreated may be even higher.

    “Given incomplete information on all comorbidities in our study, it is likely that we underestimated the complexity of health status, and thus, true estimates of adults who are potentially overtreated may be even higher.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    We categorized participants according to health status based on a limited number of questions about ADL and instrumental ADL impairments and did not take into account dementia or cognitive impairment; therefore, we may have overestimated the number of adults who were relatively healthy and underestimated potential overtreatment.

    “We categorized participants according to health status based on a limited number of questions about ADL and instrumental ADL impairments and did not take into account dementia or cognitive impairment; therefore, we may have overestimated the number of adults who were relatively healthy and underestimated potential overtreatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Use of medications was based on prescriptions brought in for examination; a small percentage of medications were classified in NHANES as combination therapy and were not otherwise subcategorized, although some may have included sulfonylureas.

    “Use of medications was based on prescriptions brought in for examination; a small percentage of medications were classified in NHANES as combination therapy and were not otherwise subcategorized, although some may have included sulfonylureas.”
    Quote in the paperNot a substantial claim
26 of 26

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Tight glycemic control with a target A1C of 6.0% may not be ideal for older/frail individuals, those with longer duration of diabetes, advanced coronary artery disease (CAD) and a known history of severe hypoglycemia.

    “Therefore, it has been suggested that a tight glycemic control with a target A1C of 6.0% may not be ideal for older/frail individuals, those with longer duration of diabetes, advanced coronary artery disease (CAD) and a known history of severe hypoglycemia (32,33)”

    From Targets for Glycemic Control (2018) · cites this paper as [33]

    The Discussion (page unavailable) says intensive glucose-lowering may cause more harm than benefit, particularly in older, sicker patients. The paper also links longer diabetes duration to hypoglycemia risk, but its Methods define tight control as HbA1c below 7% and very tight control as below 6.5%, not a 6.0% target. It does not specifically make this recommendation for advanced CAD or a prior history of severe hypoglycemia. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment.

    “Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment and found to be very common in clinical practice (100-104)”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [102]

    The Discussion reports that approximately 1 million older adults with complex or very complex health attained tight glycemic control using insulin or sulfonylureas, which the authors call potential overtreatment. The claim omits that qualification: the paper does not classify every such treatment plan as overtreatment, and notes that tight control may sometimes be appropriate depending on patient goals and how it is achieved. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Intensive glycemic management in older adults with complex health status and medication plans that increase hypoglycemia risk through insulin and/or sulfonylureas has been identified as overtreatment and is common in clinical practice.

    “Intensive glycemic management in older adults, particularly those with complex health status, with medication plans that increase the risk of hypoglycemia through use of insulin and/or sulfonylureas has been identified as overtreatment, is common in clinical practice”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [111]

    The Discussion reports that approximately 1 million older US adults with complex or very complex health attained tight glycemic control while using insulin or sulfonylureas, which may cause severe hypoglycemia. It calls this *potential* overtreatment, whereas the claim describes it as overtreatment without that qualification. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Intensive glycemic management with insulin and sulfonylureas in older adults with complex medical conditions is very common in clinical practice.

    “Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment and found to be very common in clinical practice (100-104)”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [102]

  • Individuals with a long duration of diabetes, a known history of hypoglycemia, advanced atherosclerosis, or advanced age/frailty may benefit from less aggressive glycemic targets.

    “Individuals with a long duration of diabetes, a known history of hypoglycemia, advanced atherosclerosis, or advanced age/frailty may benefit from less aggressive targets (67,68).”

    From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [67]

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Related

Authors
Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A.
Affiliations
  • Yale New Haven Hospital (US)
  • San Francisco VA Medical Center (US)
  • Mayo Clinic (US)
Corresponding author
Lipska, Kasia J.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2015-03-01
Volume
175
Issue
3
Pages
356
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2014.7345
PMC
PMC4426991
OpenAlex
W1985992465
Cited by
408
References
34
Citations by year
2026: 23 · 2025: 26 · 2024: 22 · 2023: 18 · 2022: 35 · 2021: 38 · 2020: 41 · 2019: 48 · 2018: 43 · 2017: 43 · 2016: 46 · 2015: 24
FWCI
45.09
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000142)
  • National Institute on Aging (K08AG032886, L30 AG045923, K23AG030999, K23AG048359, P30 AG21342, R03AG045086, T32AG019134, P30AG021342, P30AG044281)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
diabetes mellitus, older adults, overtreatment, tight glycemic control, HbA1c, hypoglycemia, insulin, sulfonylureas, comorbidities, functional limitations, activities of daily living, instrumental activities of daily living, health status, diabetes medication use, NHANES, cost-effectiveness, quality of life
MeSH terms
Activities of Daily Living, Aged, Aged, 80 and over, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Health Status, Glycated Hemoglobin, Humans, Hypoglycemia, Iatrogenic Disease, Insulin, Male, Sulfonylurea Compounds

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